The Democratic Republic of the Congo (DRC) is reeling from an outbreak of Ebola that is estimated to have killed nearly 5,400 people. The World Health Organization (WHO) has described it as “the largest Ebola outbreak ever reported” in the country.
The outbreak was first detected in Mongbwalu, a gold-mining town of around 130,000 people in Ituri province in northeastern Congo, after the WHO was alerted on May 5 about an unusual cluster of illness and deaths. The earliest known suspected case was a healthcare worker who developed symptoms on Apr. 24 and later died at a medical facility in Bunia, the provincial capital.
On May 15, laboratory tests confirmed that the outbreak was caused by the Bundibugyo virus. Since then, the epidemic has spread to the eight provinces, with about 65% of new cases occurring in the community, suggesting widespread undetected transmission. The virus spreads primarily through direct contact with an infected person’s blood or other bodily fluids, or through contact with contaminated materials and surfaces. As a zoonotic disease, Ebola can also pass from infected wildlife to humans.
The epidemic is now spreading fast and far beyond the borders of Congo, reaching Uganda, Kenya, and Nigeria. The WHO, the Africa Centers for Disease Control and Prevention (Africa CDC), and other public health experts have identified several obstacles to containing the outbreak: the lack of an effective vaccine against the Bundibugyo virus, armed conflict in eastern Congo, inadequate healthcare infrastructure, and cuts to international health assistance.
What this list leaves out is a deeper problem: a decades-long crisis of governance. Ebola is particularly difficult to control in Congo because its ruling class has done little to care for the health and well-being of most Congolese.
The Trump Administration has compounded the problem by weakening the American and international institutions. Dismantling the United States Agency for International Aid (USAID), ending foreign assistance programs, cutting staff at the U.S. Centers for Disease Control and Prevention (CDC), and withdrawing from the WHO have undermined disease surveillance, outbreak preparedness, and emergency response.
Funding cuts have also weakened support for disease detection, community surveillance, medical supplies, and frontline health systems in Congo.
The cold warrior’s curse
The roots of endemic corruption and weak governance in Congo reach back decades. In 1965, five years after the country’s independence from Belgium, Mobutu Sese Seko, the army chief, seized power in a coup. He aligned himself with the U.S. during the Cold War and ruled with absolute power, using the machinery of government to enrich himself and his most senior officials while neglecting the basic functions of the state.
During the final decades of Mobutu’s rule, civil servants across the country—soldiers, police officers, doctors and teachers—were paid a pittance. Even their meager salaries were routinely stolen by officials a rung or two above them. This was the system Mobutu bequeathed to his successors. It endures today.
The consequences of this failure of governance are stark. Ebola is killing people not only in remote, rural communities but also in cities such as Kisangani, home to more than 1.5 million people and far from the conflict in eastern Congo. A substantial proportion of Ebola deaths have occurred outside healthcare facilities.
During a recent two-week reporting period, the WHO found that approximately 65% of deaths occurred in communities rather than treatment centers. These deaths expose the failures in early detection, timely referral, and access to appropriate medical care. The deaths in Kisangani suggest a near-total breakdown of the public health system in Congo beyond the conflict zone.
Congo’s health care system has been deteriorating since the 1990s, when economic collapse, political instability, and crumbling state institutions eroded the government’s ability to finance and deliver basic public services. The two successive Congo wars, which began in 1996 and 1998, destroyed health facilities, displaced communities, and disrupted essential services. Dependence on foreign aid grew. Meager government investment, weak accountability, fragmented donor support, and high cost of treatment continued to put access to essential services beyond the reach of most Congolese.
Today, Congo’s health care system is in tatters. Successive governments have done little to repair it. In cities like Kisangani, basic health care is barely available. Conditions are much worse in rural areas. Health care workers go unpaid, and morale is low.
In August, Roger Kamba, the health minister, acknowledged that 15% to 20% of the names added to payrolls for Ebola response belonged to “ghost workers,” fictitious employees invented by poorly paid officials to siphon off funds. Many frontline health workers fighting Ebola have not been paid for most of this year; in August, many of those workers went on strike while the epidemic surged.
African lessons
It does not have to be this way. Earlier this year, Ebola spread rapidly from Congo into neighboring Uganda. While the epidemic raged on in Congo, Uganda contained it. According to The Lancet, Uganda’s Ministry of Health “announced the end of the outbreak on July 28, after 42 days without a new confirmed locally transmitted case.”
Congo is among the most corrupt and poorly governed countries in the world, according to Transparency International and Freedom House. Like Congo, Uganda, too, is poor, facing challenges of corruption, weak governance, and shortage of resources. But Uganda has built public health institutions that can respond quickly to epidemics. Years of tackling Ebola and other viral hemorrhagic fevers have given its health officials substantial institutional experience, which they drew on as the virus crossed the border.
Uganda’s Ministry of Health rapidly identified cases, isolated patients, began treatment, and traced and monitored their contacts. Officials identified more than 800 contacts during the outbreak and halted local transmission. They also stepped up surveillance in health facilities and communities, strengthened infection prevention and control measures, and coordinated the response at border crossings.
Those systems allowed Uganda to detect imported infections before they could spark sustained community transmission. Effective epidemic control depends not only on medical tools but also on functioning public institutions that can act quickly, coordinate across sectors, maintain public trust and reach communities before transmission becomes widespread.
International partners including the WHO, Africa CDC, the European Union, the World Bank and the United Nations Children’s Fund have helped both countries respond to Ebola. But delivering assistance to Congo is a struggle. Armed conflict, damaged infrastructure, and restricted access to affected communities make it difficult to deploy response teams, deliver medical supplies, and conduct surveillance and contact tracing. A weak healthcare system, shortages of frontline workers, funding gaps, and poor coordination compound the challenges.
For decades, Congo relied heavily on USAID during successive humanitarian crises. The agency’s dismantling, America’s withdrawal from the WHO, and cuts to the CDC have weakened international response to epidemics. With international support, countries with relatively strong health systems, such as Uganda, can contain Ebola. But countries such as Congo, where corruption has hollowed out the healthcare system, are harder to help when international institutions themselves have been weakened.
The consequences reach far beyond Congo. The country has a population of more than 100 million people, is the largest in sub-Saharan Africa, and borders nine other countries. The consequences of its dysfunction create problems that spill across its borders. The detection of Ebola cases in Kenya and Nigeria, neither of which borders Congo, shows how far the effects of failed disease control can travel.
Other countries and institutions have tried to help fill the gap. The European Union, the World Bank, Germany, Britain, African governments, and China have contributed funding and other resources. China, which has substantial interests in Congo’s cobalt and copper sectors, pledged $18 million in assistance and deployed medical experts to help tackle the outbreak.
These contributions matter. But containing the outbreak depends on sustained funding for frontline health workers, community surveillance, contact tracing, laboratory testing, and treatment.
Congo’s failures of governance and public health cannot be repaired promptly. International assistance must reach affected communities and offer local health workers the means to act. By weakening the institutions that help contain outbreaks, the Trump Administration has contributed to placing people in Congo, and far beyond it, at greater risk.
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